Stem cell model PA/Physician program idea

[EMEDPA]

there has been a lot of talk here recently about getting pas credit for their prior schooling towards md/do.

toward that end I suggest the following concept of a hybrid stem cell pa/physician program.

 

standard medschool prereqs(basically pa prereqs in 2013)

no mcat (several medschools already do this so would not be earth-shattering)

2000 hrs quality hce requirement

 

all students do all of ms 1 then take usmle/comlex step 1

all students do all of ms 2

all students do all of ms 3 and take usmle/comlex step 2 with option to take pance

PA track students graduate with an MMS and option to enter a 1 yr doctoral(DMS) residency in specialty of choice

Physician track students do all of ms 4 and apply for the physician residency match.

PA commitment 3-4 yrs(if they do optional residency)

MD/DO commitment 7 years minimum.

no restrictions on what field graduates may apply for although like lecom spots could be reserved for those with an interest in primary care.

PA who later decides to complete medschool already having passed usmle step 1 and 2 and pance completes ms4 and applies to the physician match

 

this means a pa returning to school would only be 1 yr without salary and then would be earning again as a resident and would get credit for 100% of work previously done.

discuss.

[primadonna22274]

Not a bad notion E. I am a fan of the stem cell model although I realize it would put many community programs not affiliated with a medical school out in the cold (like my own alma mater, Pacific U in Oregon, which has been putting out darn good PAs the past 15 years).

Level 1/step 1 needs to move to end of year 2 as it covers all core basic sciences and all major systems. You could argue to condense that to March or so and test then, leaving some "softer" sciences for April-May (bioethics, spirituality in medicine, human sexuality etc) although those topics come up frequently on step 1. You definitely have to cover biostatistics as step 1 material as that is heavily represented.

 

[EMEDPA]

You definitely have to cover biostatistics as step 1 material as that is heavily represented.

again??? I have taken stats twice(once as an undergrad and once at the Doctoral level) and done well both times but can't say I enjoy the material.

[primadonna22274]

Oh I hate it too E but biostatistics showed up at least 5-7% of my COMLEX level 1 and USMLE step 1 exams. Much less on step 2.

[jsfelder0417]

Do ya'll that have more time in this field think that something like this could actually come to fruition?

[primadonna22274]

Do ya'll that have more time in this field think that something like this could actually come to fruition?

I do. It might take another 20-30 years but I have at least that many left and it's on my audacious list of things to do to reform medical education. :)

[EMEDPA]

a recent world health organization position paper would also support this effort.

[Hemegroup]

again??? I have taken stats twice(once as an undergrad and once at the Doctoral level) and done well both times but can't say I enjoy the material.

i've taken both psych stats 1 and 2 and biostats. apa-style shredder here.

[EMEDPA]

I took "stats for research methodology" last term. The prof said " I will give a letter of recommendation to anyone who passes this class to teach undergrad stats if they so desire". no thanks.

[blueridge]

The World Health Organization:  WHO Global Code of Practice on the International Recruitment of Health Personnel:

 

http://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdf

http://www.who.int/hrh/migration/code/background_paper_code.pdf

http://www.nejm.org/doi/full/10.1056/NEJMp1108658

 

The WHO Code of Practice could also be a huge catalyst to speed up the efforts (transitioning PAS) in this discussion.  Since the US is a major player in the brain drain of the world's physicians, even from countries having severe physician shortage, and this CODE is essentially a plea for ethics and reason to prevail, having PAs transition is an efficient and near immediate answer to this call.  

 

http://www.amednews.com/article/20121003/profession/310039996/8/

 

See the irony in these examples (India and Pakistan) - the shortage left behind seems to be of no concern to US lawmakers:

 

http://www.dawn.com/news/1061111/more-employment-opportunities-in-us-for-doctors

http://www.ibtimes.com/pakistan-already-suffering-doctor-shortage-losing-physicians-greener-pastures-middle-east-1401549

 

http://triplehelixblog.com/2012/03/shortage-of-indian-medical-professionals/

http://health.india.com/news/indian-american-doctors-seek-end-to-physician-shortage-in-the-us/

 

Even as the WHO calls for remuneration from countries who are guilty in perpetuating such brain drain (England already makes some financial compensation), our US lawmakers seem oblivious to the WHO Code of Practice and, furthermore, will likely not compensate such countries in the future.  The US does however provide medicare dollars to fund residency programs for foreign doctors.  Lots of irony...

 

This WHO Code of Practice needs to be on the desk on every member of the US Congress as soon as possible.  Transitioned PAs are a partial solution to the brain drain (the pull factor) of foreign doctors, and if the US was less obliging, then the countries facing shortages and having some of the push factors (low pay, crummy facilities, etc.) will be more apt to repair their own contributing issues (also addressed in the Code of Practice).

 

The time is ripe for the pulling of ears and the contorting of consciences of Congress, who as a whole is in violation of the WHO Code of Practice, and as a prime country who lures foreign doctors Congress must be made aware of the consequences - the damaging impact to world health.  

[blueridge]

The polished version of the WHO Global Code of Practice on the International Recruitment of Health Personnel:

 

http://www.who.int/hrh/migration/code/code_en.pdf

[Guest Paula]

Does anyone in Congress have a conscience?

[blueridge]

Also for consideration:

 

From the recent Third Global Forum on Human Resources for Health:

 

http://www.who.int/workforcealliance/forum/2013/en/index.html

 

This forum addressed how countries need to develop policies that affect global healthcare inequity and the migration of workers.

 

This article (Nov. 2013), Empirical impact evaluation of the WHO global code of practice on the international recruitment of health personnel in Australia, Canada, UK and USA, compliments the above mentioned forum findings:

 

"Another civil society respondent from the USA agreed, saying, 'Only those few colleagues who work specifically on global human

resources for health issues are aware of the Code. Among health policy and health services research colleagues there is little or no awareness'” 

 

http://www.globalizationandhealth.com/content/pdf/1744-8603-9-60.pdf

 

Both WHO position statements, Transforming and scaling up health professionals' education and training (http://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng.pdf) and the Code of Practice could work in concert to accelerate the transformation of the PA profession.  

 

 

[eddoc]

Blue - I attended the Global Forum in Recife and given the topics discussed there am a little confused regarding your statement regarding accelerating the "transformation of the PA profession."  Transforming it to what exactly? Are you suggesting that recruiting fewer foreign trained physicians would lead to greater reliance on US PAs?  If one buys, as the US appears to do, that only a physician (no matter how poorly trained) will do then the recent move to decrease IMG barriers to practice in the US is the direction that policy makers might well take.  Impact on the PA profession is more likely to come from the various African analogues who have demonstrated that "associate clinicians" with expanded scope of practice deliver care equivalent to or better than doctors in their respective countries.  Unfortunately, the data that GHWA has gathered is fairly thin and as a result, Framework 6 does not recommend formally delegating some procedures to associate clinicians that are delegated to nurse midwives because of the paucity of research.

[blueridge]

eddoc - Transformation, the ability for those seasoned PAs who choose to pursue such a (doctorate) pathway to independent practice, thus having the ability to practice in the capacity of a physician (as a MD/DO or something like a PA-D), therefore being addressed Dr. in a clinical setting.  This is a reasonable and near immediate approach to addressing the "physician shortage" in America without relying on the luring and plucking of physicians from countries that have suffer severe shortages of physicians.  The acceleration aspect is taking WHO at its word regarding the recommendations in the above mentioned "Transforming and scaling up health professionals" education and training."  And this brings us back to the WHO Code of Practice, which appears to being virtually ignored by our lawmakers.  The "stealing" of the world's doctors cannot be thought of as a proper way to deal with our own perceived shortages.  A glimpse of the past (1959) World Health for World Peace (Washington DC conference) is interesting to read, and the current and widespread and increasing methods of stealing of doctors may well come back to bite us. (

[MedicinePower]

This sounds very good and is more or less the Chinese model.

 

https://en.wikipedia.org/wiki/Assistant_Doctor

 

http://www.unhcr.org/refworld/pdfid/4b6fe1b10.pdf

[JohnnyM2]

Emdpa, Great suggestion. For one, it clearly distinguishes PAs from nps and provides a path for PAs to either get a doctorate or continue on to med school or return to med school later. The problems getting there are legion, however. Who teaches the first and second year courses? MDs, PAs? Are students entering med school or PA school? Requires radical changes in certification. Are PAs trained in these programs better than those trained in traditional PA schools? Fierce turf battles, just to mention a few. But the idea has merit and needs an open hearing. It has my support but I wouldn't know how to get it off the ground and doubt the AAPA would endorse it.

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[EMEDPA]

as long as it met min requirements for both pa and md there would be no reason not to accredit it. I'm not talking all programs, just one to start. that would be all it took.